History and Physical Schpeels

Posted bythespinebookPosted inAnatomy, Topics

History 

  • AMPLE 
  • Mechanical pain 
    • OPQRST 
    • Extension vs flexion 
    • Positional improvement 
    • Back vs buttock, midline vs paramidline 
    • Back dominant vs leg cominant 
  • Deformity 
    • Noticed change to ribs or spine 
  • Myelopathy 
    • Changes in gait 
    • Balance 
    • Fine motor (buttoning shirt, handwriting) 
  • Neuro 
    • Changes to sensation or moto funcion 
    • Claudicant 
      • Vascular vs neuro 
        • Neuro 
          • Better with flexion 
    • Radicular 
    • Bowel bladder saddle 
    • Erectile dysfunction 
  • Constitutional 

Spine Physical 

I would perform a thorough neurologic exam as per ASIA guidelines 

  • Inspection, sensation, power, tone and clonus, reflexed, coordination 
  • Coordination/ Gait 
    • Radicular – trendelenberg, steppage, antalgic 
    • Myelopathy – wide based 
    • Grip release 
  • Inspection 
    • Saggital and oonal 
    • Forward adams for rib cage 
  • Sensation – pin prick, light touch, including saddle area and DRE 
  • Power – all myotomes 
  • Tone – clonus is 3 beats 
  • Reflexes 
    • Triceps, biceps, BR 
    • Knee ankle 
    • Babinksi, Hoffman